the scariest thing

If you are a healthcare provider, you should be scared. If you are a healthcare consumer or a patient, you should be terrified. If you require prescription medication, or physical, occupational, or speech therapy, or you require mental health services, if you are raising children or caring for an aging parent, you should be afraid.

"A healthy person has a hundred wishes,

but a sick person has only one."

~A.G. Riddle~

We should all be worried because the people we depend upon to protect our health and well-being have been dismissed and replaced with people who have no training, or knowledge, or experience in medicine. We are losing the experts we need to develop the drugs that we use to manage diabetes, hypertension, and heart disease, infections, and cancer. To monitor and manage public health threats. To protect our children. To man suicide hot-lines. The list goes on...and on...and on. Jobs have already been lost. Staff, dismissed. Offices, closed.

We should be worried because research into advanced techniques and treatments will cease as the grants that fund medical research disappear. People who are enrolled in clinical trials will be abandoned and lost to follow up.

It's scary to imagine what will happen to people who will no longer be able to afford health care. To people who won't be able to afford their medication. To people who will lose the benefits they need for mental health treatment, substance abuse recovery programs, and protective services.

Measles cases are on the rise. People have already died. Unnecessarily. Drug-resistant tuberculosis is on the rise. HIV prevention has taken a hit.

"Not everything that is faced can be changed,

but nothing can be changed

until it is faced."

~James Baldwin~

It's all very scary. Heart breaking, actually. But this is the scariest thing of all:

WE ARE ALL FEELING HELPLESS TO PREVENT

THE GUTTING OF OUR HEALTHCARE SYSTEM!

All the phone calls, all the letters and emails, all the demonstrations that we have traditionally relied upon to make our thoughts and feelings known to our leaders--our frustrations, our anger, our disbelief, our fear--are falling on the deaf ears and blind eyes of the people we depend upon to lead us into the future. 

"I am not afraid of an army of lions

led by a sheep.

I am afraid of an army of sheep

led by a lion."

~Alexander the Great~

No one seems to know what to do. Or where to begin. Or how to go about it. Perhaps they simply lack the backbone to take a stand against what is happening. Or, they lack the courage to begin.

What will you do to protect your patients? To support the research, services, and human decency that you dedicated your career to? 

While you think about it, try this: 

Extend a simple kindness to someone.

Do something that will make the moment just a little bit safer, easier, or happier for someone.

Smile at or with someone.

Feed someone.

Hug someone, or if that's going too far, hold someone's hand, or wave to them.

Be nice.

In other words:

"Do what you can

with what you have

where you are."

~Theodore Roosevelt~

Something will come to you...

jan

writing to heal

 

Some time ago, I talked about the ACE (Adverse Childhood Experiences) Score and how childhood trauma can cause epigenetic changes in the young brain that trigger an overactive inflammatory response. This has been shown to lead to disease states in adults, such as autoimmune conditions like lupus and rheumatoid arthritis, heart disease, diabetes, stroke, depression, and PTSD-like anxiety and reactivity. Luckily, epigenetic changes can be reversed. Healing is possible.

"What is the source of our first suffering?

It lies in the fact that we hesitated to speak.

It was born in the moment when we

accumulated silent things within us."

~Gaston Bachelard~

Among the practices that have been shown to promote epigenetic healing is writing to heal. Researchers at Carnegie Mellon found that the simple act of writing and reporting on an emotional state had a significant effect on the body's physical state. It improved measures of immune function even in patients battling life-threatening diseases. It reduced markers of the stress response by lowering the heart rate and blood pressure. It lowered rates of depression, addiction, anxiety, and PTSD. The damaging effects of ACEs can last a lifetime, but they don't have to. 

"I write because silence is a heavy weight to carry.

I write to remember.

I write to heal."

~Andrea Gibson~

Bernie Siegel, MD, uses "writing to heal" in his workshops. He prompts students to write on the topic of  "why you love yourself." Then he asks them to write about why they might want to end their lives. They are usually surprised to see that the compilation of pages they have written about why they should commit suicide is many times greater than the collection that considers why they should love themselves. Whether their stories are about emotional pain or physical pain, Siegel encourages them to break the silence that has been wreaking havoc on their minds and bodies all their lives without their awareness or understanding.

In another study, one group of participants was asked to write about a personally traumatic experience for 15 minutes daily for four days in a row, while another group wrote about an emotionally neutral topic. The first group reported improved mood, improved memory and sleep, reduced pain, fewer intrusive negative thoughts, and reduced blood pressure compared with the second group.

It is hypothesized that writing exerts its positive physiological effects by reducing the levels of inflammatory substances that accumulate when traumatic or painful thoughts and emotions are denied, repressed, or otherwise silenced. Acknowledging, describing, and releasing those feelings through writing may allay anxiety, reduce stress, and promote healing.

Hence, my interest in the practice of narrative medicine.

If you would like to give it a try, or if you want to offer this tool to your patients, here are a few general guidelines for getting started:

• Find a time and a place to write without distraction or interruption.
• Try different modalities, such as writing long hand in a journal, tapping it into your laptop or phone, or dictating and transcribing your story.
• As you write your first draft, do not worry about or let yourself be sidetracked by correcting grammar, spelling, or usage.
• Forget what you imagine others will say about your writing.
• If what you are writing about makes you increasingly anxious, set it aside. Focus, instead, on self-care. Take a walk outside. Take a nap. Have something good to eat. Call a friend. Return to writing when you are ready.

"Self-care is a divine responsibility."

~Danielle LaPorte~

The simple act of putting our stories into words can help us heal both psychologically and physically. When we share our story with others, it can help them heal, as well. And isn't that what we are here to do? To help others heal?

"The healing that can grow 

out of the simple act of telling our stories

is often quite remarkable."

~Susan Wittig Albert~

jan

five succinct bullets

Last week, Elon Musk directed all federal workers to submit a list of five things they had accomplished at work in order to justify keeping their jobs...or risk being fired. A few days later, they were advised to ignore the order. Then, without explanation, they were redirected to comply with it. Needless to say, this resulted in total chaos. In fear, anger, and confusion. 

"...use this as an opportunity

to shine and show off what you do

in five succinct bullets."

~Elon Musk~

I'm retired, so obviously, this doesn't apply to me. Still, I thought it might be fun to try it (tongue in cheek...). So, here it is:

1. When my plans for the weekend fell through at the last minute, I decided, instead, to drive to Pittsburgh to surprise my son who was celebrating the first year anniversary of his very own craft brewery, CoStar Brewing. Check it out at https://www.costarbrewing.com/. I think it pleased him when I showed up unannounced.

2. I spent either an hour in meditation or two hours walking in the countryside every day.

3. I read. I'm reading "Coming to Our Senses" by Jon Kabat-Zinn in preparation for a meditation retreat with him later this year. It's a big book! It'll take a while for me to get through it.

4. I woke up early to enjoy the sunrise.

5. I fed the birds, squirrels, and the deer out back with the "good" (meaning "expensive") birdseed every day. 

Granted, this might not be the type of activity that would impress Musk, but it serves to keep me balanced and relatively calm in spite of the chaos. It helps me stay in touch with reality even when it scares me. It keeps me sane, unlike some people I know...

"When something is important enough,

you do it even if the odds

are not in your favor."

~Elon Musk~

jan

 

make me care

 

The art of storytelling is as old as the spoken word. It entertains, informs, and connects mankind across culture, race, and creed. It has the power to heal, and in medicine, it can be a life-saving skill.

Most people enjoy reading or listening to stories at their leisure. The health care provider, on the other hand, listens to stories all day long because it's part of his job. This is how he obtains the "history of the present illness," perhaps better described as the "story of the present illness." It forms the basis of all that follows: performing the physical examination, tracking down the diagnosis, and formulating a treatment plan.

The clinical encounter begins when the health care provider takes the patient's history. He listens for specific details that lead him to the diagnosis. If the problem is pain, the provider wants to know where it's located, and whether it's sharp or dull, steady or throbbing, constant or intermittent. He wants to know how long the patient has had the pain--for a day? For a month? For years? What makes it better? What makes it worse? These details guide him through a maze of possibilities.

"The shortest distance

between a human being and the truth

is a story."

~Anthony de Mello~

The problem is that patients don't know what the provider needs to hear. They don't arrive at the office prepared to rattle off a list of relevant signs and symptoms. It's the provider's job to ask about them, but he only has so much time to get to the bottom of the patient's problem. Nowadays, the written or dictated clinical note has been largely replaced by the electronic medical record (EMR), so rather than listen to the patient's history, the provider navigates his medical record with a series of clicks that pull up an array of bulleted lists, complicated charts, and sketchy details. This is intended to expedite what has been ruthlessly abridged to a ten-minute office visit.

Because time is limited, doctors often redirect the patient who appears to be getting off track or is slow coming up with answers. In fact, one frequently quoted study found that physicians interrupt and redirect the patient when they are as few as 18 seconds into the interview. Frequent redirection leads the patient to believe that what he wants to say isn't important or relevant, so details go missing.

This is a problem. Healing, or failing to heal, occurs in the context of a person's relationships with his family and friends, his surroundings, expectations, and perceptions, as well as his emotional, psychological, and spiritual life. If the patient is denied the opportunity to tell his whole story, part of him may never heal.

"Healing yourself is connected to

healing others."

~Yoko Ono~

Let's say, for example, that the patient presents with abdominal pain. He answers all of his doctor's questions. The pain has been present for four days. He describes it as constant. It started in his upper abdomen, but now it radiates into his back. Eating makes it worse. In fact, the patient says he hasn't been able to keep anything down for the past twenty-four hours. After a focused physical exam and a few tests, the physician correctly diagnoses the problem as acute pancreatitis. But that doesn't explain why the patient develops a headache, has trouble keeping his balance, and becomes confused the day after he is admitted to the hospital.

What the doctor doesn't know is that the patient has been drinking heavily because his wife walked out on him recently. In fact, he blacked out a couple of days ago and woke up on the floor next to his bed. He didn't mention it because he was busy answering the doctor's questions about his abdominal pain. So, the doctor missed the small subdural bleed his patient sustained in the fall until days later when he had his first seizure.

This scenario highlights an important problem. Obtaining an accurate and thorough medical history takes time. Given the imperative to see more patients faster, the provider may have little time to explore the details of the medical history with every patient. Perhaps he's running behind schedule, or an emergency interrupts him. In some cases, the patient can't bear to disclose the sorrow, or fear, or shame that underlies his symptoms, so he doesn't mention it. It takes time to invite, enable, and encourage some patients to share the story that brings them to the office in the first place.

"Storytelling is the essential human activity.

The harder the situation, 

the more essential it is."

~Tim O'Brien~

When the patient is constantly redirected in order to satisfy the provider's agenda, important parts of the story may be overlooked. This reinforces the importance of hearing the patient's full narrative. When we reach into their cholesterol laden hearts to understand why they are poisoning themselves with food, we need to know more than what they are putting into their mouths. When a patient is noncompliant, we need to consider what he is afraid of, or angry about, or grieving over. When we allow the patient to speak, we may discover that the reason for this one's fatigue, or that one's intractable headache is end-stage disappointment, or anger, or shame that has festered for years.

Only then can we help them heal.

"The greatest story commandment is:

Make me care."

~Andrew Stanton~

jan

bipolar tendencies

If you weren't downright bipolar before the November election, you might be tending in that direction now, torn, as we are, between fear, dread, and uncertainty...and the bravery it takes just to make it through the day. Between periods of chaos, and moments of peace. Between utter despair, and a faint glimmer of hope. Between anger and gratitude. Sorrow and surrender.

"I'm not bipolar.

I've just had a bipolar life

foisted upon me."

~www.healthyplace.com~

We are only a few weeks into this, and there is no end in sight. How will we make it through? And who will we be when we come out on the other side?

"Life can be like an emotional roller coaster

with its ups and downs.

What matters is whether you are keeping

your eyes open or closed

during the ride..."

~Ana Ortega~

Like our eyes, it is important to discern whether our hearts are open or closed to this journey. How are we coping? In Buddhism there are four fundamental practices that are designed to open the heart: lovingkindness, compassion, empathetic joy, and EQUANIMITY:

"Equanimity: 

mental calmness, composure, and

evenness of temper,

especially in a difficult situation."

~from word-struck~

As Jack Kornfield puts it, "Equanimity arises when we accept the way things are." He doesn't suggest we give up in the face of adversity, or we passively embrace or simply succumb to whatever comes our way in life. He doesn't encourage denial, or indifference, or surrender. He means we acknowledge reality, and reflect deeply on the truth. Then we act out of lovingkindness, rather than giving way to our habitual tendency to judge, blame, retaliate, or cling to resentment and anger. This is not an function of the intellect, a decision we make, or a promise we commit to. It is a practice. A process. A way of life.

"When you find your center

you will not be drawn to someone else's storm.

Instead they will be drawn

to your peace."

~Becky Bro~ 

What if you could find a way to get off the emotional roller coaster that takes you nowhere? Wouldn't you gladly abandon the path that leads you in circles, up the same steep hills, down the same scary slopes, around the same predictable curves, again and again?

Imagine what it would feel like to escape the anger, fear, and confusion that habitually repeat themselves in your life. To tear up the ticket that gets you through the gate to envy, shame, and despair as we head into our uncertain future.

What if, instead, you could be steadfast and strong? Peaceful and calm. Wise and reflective. What if you could bring the whole bipolar ride to a grinding halt? 

How would you do that? What would it take? Who will you become?

Remember this: Teachers abound. You can begin now.

As Poe put it:

"Deep into that darkness peering,

long I stood there,

wondering, fearing, doubting, dreaming,

dreams no mortal being

ever dared to dream before."

~Edgar Allan Poe~

jan

why you should take up writing

 

I often find myself encouraging my family, friends and even random acquaintances to take up writing. I may have heard their stories over a glass of wine or a cup of good strong coffee, on a hike in the woods or on the beach, so I know they can do it. I nag them because I know someone who needs to hear their story. Someone recently diagnosed with cancer needs to hear from a person who has been through it. They need to know the diagnosis was devastating, the treatment grueling, the recovery painstaking, the victory glorious. If you're a caretaker for someone who isn't doing well, or you're battling illness yourself, it helps to know how difficult it is for others in the same situation. How they cope. How they keep their spirits up.

"If you want to change the world,

(...and don't we all?)

pick up your pen and write."

~Martin Luther~

I encourage people to write even though I know how hard it can be to get words on the page. To stick with it. To go back to it again and again. Like meditation, it can be hard to quiet your mind while sitting alone, in silence. Our minds like to be busy, thinking back on things that have happened, thinking ahead to what awaits us, guessing, planning, judging, fretting, when our goal is to stay focused on the work at hand.

In meditation, when our minds wander, we are encouraged simply to acknowledge the interruption and refocus, not to chastise ourselves for getting distracted, or berate ourselves for letting our attention wander. When unbidden thoughts arise, we label them "just thoughts" or "just thinking," and we move our attention back to the breath--in, out, in, out. Letting go of intrusive thoughts helps mitigate the impact of negative emotions such as anger, anxiety, bitterness, and resentment that may have a stranglehold on us.

"You should sit in meditation

for twenty minutes a day, 

unless you're too busy;

then you should sit for an hour."

~Old Zen Saying~

This, I believe, is a practice writers should embrace. We are accustomed to labeling our own negative thoughts as "voices" we hear. It's an interesting metaphor. We are advised not to pay attention to the voices of negativity that discourage our creative efforts. Voices that insist we're wasting our time, that we have no talent for this kind of thing, that we have no hope of success. Voices that make us feel inferior, or guilty for indulging in something we enjoy when others are so hard at real work.

"Tell the negative committee

that meets inside your head

to sit down and shut up."

~Ann Bradford~

The point is those negative voices are just thoughts. Just echoes from the past, not worth arguing about. They are opinions, and they do not have your best interests at heart. Banish them! Return to the breath. Or take a walk. Or call up a friend, someone who encourages you, and supports your dream. Someone who understands how hard this is, and respects you for trying. Someone whose friendship isn't invested in your wealth or fame. 

Do whatever it takes to stay on the optimistic side. Do whatever it takes to tell your story. Turn your attention to the truth:   

"People start to heal

the moment they feel heard."

~Cheryl Richardson~

jan

close encounters of the hardest kind

 

  

This was a fairly average week for me as I moved in and around my community. I ran into three women I know who have lost children, one of them to suicide. I spotted a patient of mine at the mall who is losing her fight against cancer, and another one who is still waiting for her test results. I spent an evening with a friend who donated a kidney to save her brother’s life.

 

Because I practiced medicine in my community for over thirty years, I have a unique vantage point when it comes to knowing who is in pain. I run into patients on the street, at the post office, and in the sub shop in town. I know who just had open heart surgery, whose marriage is in trouble, and who is battling addiction. Still, I don’t think these encounters are unique to physicians.

Whether we realize it or not, we all live among people who have endured heartache and suffering that would bring Job to tears. We encounter them wherever we go. The problem is we don’t always recognize them.

"It may take a doctor
to diagnose someone's disease,
but it takes a friend
to recognize someone's suffering."
~www. WishesMessages.com~

You can’t always tell by looking at a person what they’re up against—that divorce is in the air, or that a coworker’s cancer came back. It’s hard to know when someone is contemplating suicide. They don’t want anyone to know so they do what they can to hide it.

Many people who are in pain get out of bed in the morning just like the rest of us. There is nothing strange or special about the way they dress. They get their children off to school, and spend time tending to the house or they go to their jobs. They are right there behind us in the checkout line at the grocery store, on the treadmill next to us at the gym, or on the cushion next to us in meditation. We can’t see their broken hearts or crushed spirits so it can be hard to pick them out of the crowd. 

"The moment you change your perspective
is the moment you rewrite the chemistry
of your body."
~Bruce Lipton, Ph.D.~

This means a couple of things. First of all, if we don’t know their stories, we can’t help people heal. When we meet them on the street, we can comment on the weather, or commiserate over the sad state of politics in our country, or chat about the grandchildren, but we are prevented from expressing our concern for them, or sharing words of comfort and encouragement. In our offices, we ask about the onset, severity, and timing of their symptoms, but our questions dance around the underlying pain that is eating them alive. As health care providers, therapists, and caretakers, as neighbors and friends, as co-workers and acquaintances, we are helpless unless we know the whole story. The true story.

But enough about us.

Untold illness narratives have a way of hiding out in the subconscious while wreaking havoc with the body. They play tricks on people. As Rita Charon puts it, in her ground-breaking book, "Narrative Medicine--Honoring the Stories of Illness": “The body and the self keep secrets from one another.” The body may experience chest pain, when the problem is despair. The patient may see a physical therapist for a back injury when the cause of his pain is anger. People may turn to opiates for relief when their pain arises out of fear.

"The healing process begins
when patients tell of symptoms
or even fears of illness--
first to themselves, then to loved ones,
and finally, to health professionals."
~Rita Charon, M.D., Ph.D.~

Unless we seek out and explore the anger, or despair, or fear that is at the root of their pain, nothing we say or do will relieve the cause of suffering. All the medication in the world will not solve the problem.

“The shortest distance between
truth and a human being
is a story.”
~Anthony de Mello~

jan